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RECAP 


HX64069346 

RK61  H34  Everyday  mouth  hygie 

Jiveryday 
Mouth  Hygiene 

Joseph  HEAl),M.D..D.ns. 


fRKIol 


m4l 


Columbia  ©nibers^itp 
intJjeCitpofi^etDgork 

College  of  ^fjpgidansi  anb  ^uigeonsi 


3^eference  Hibrarp 


Presented  by 

^^DR.  WILLIAM  J.  GIES^ 

to  enrich  the  library  resources 

available  to  holders 

of  the 

GlES  FELLOWSHIP 

in  Biological  Chemistry 


Everyday 
Mouth   Hygiene 


By 
Joseph  Head,  M.  D.,  D.  D.  S. 

Dentist 

to  the  Jefferson  Hospital 

Philadelphia 


Illustrated 


Philadelphia  and  London 

W.  B.  Saunders  Company 

1921 


Copyright,  iq20,  by  W.  B.  Saunders  Company 


Reprinted  February,  ig2i 


H34 


PRINTED    IN    AMERICA 


PRESS    OF 

W-     B.     SAUNDERS     COMPANY 

PHILADELPHIA 


PREFACE 


Decay  is  not  a  normal  condition  of  the  mouth. 
Cleanliness  of  the  teeth  and  gums  will  absolutely  pre- 
vent decay,  and  may  sometimes  cure  it.  Up  to  the 
present  all  methods  of  cleansing  the  mouth  have  been 
failures,  as  they  have  not  thoroughly  removed  the  mass 
of  infection  from  between  the  teeth  and  the  surface  of 
the  gums.  Mouth  disease  spreads  throughout  the  body, 
causing  prolonged  sickness  and  death. 

It  is  hoped  that  this  little  book  will  be  an  inspira- 
tion to  loving  mothers  and  conscientious  nurses,  so  that 
future  generations  will  acquire  the  correct  principles 
of  mouth  cleansing,  and  thus  the  terrible  disease  of 
mouth  infection  will  be  banished  from  the  human  race, 

Joseph  Head. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/everydaymouthhygOOhead 


EVERYDAY   MOUTH   HYGIENE 


Infection  of  the  teeth  and  gums  causes  directly  or 
indirectly  one-half  of  the  fatal  diseases.  This  infection 
exists  because  the  teeth  and  gums  are  not  kept  clean. 
Five  minutes  a  day  properly  expended  vnLl  really  cleanse 
the  teeth  and  gums  if  the  disease  has  not  progressed 
beyond  the  superficial  stage,  and  if  the  disease  is  within 
the  possibility  of  actual  contact  of  the  tooth-brush  and 
dental  floss.  The  daily  cleansings  cause  the  gums  to 
heal  and  render  them  less  likely  to  receive  infection  in 
the  future. 

The  film  or  scum  that  ordinarily  collects  upon  the 
teeth  and  gums  is  not  food  deposit,  it  consists  of  masses 
of  bacteria  that  attack  the  tissues,  and  if  undisturbed, 
break  down  the  vital  resistance  and  form  lodgments 
which  send  constant  streams  of  poison  and  bacteria 
throughout  the  body. 

Figure  1  represents  two  lower  teeth  at  approxi- 
mately the  age  of  ten.  The  shading  shows  the  healthy 
bone  around  the  roots.  The  line  A  at  the  neck  of  the 
teeth  shows  the  normal  gum  line.  The  space  between 
the  teeth  and  around  the  gum  is  clean  because  the 
mother  of  the  child  has  used  the  dental  floss  to  wipe  out 
the  space  each  day,  and  then  the  tooth-brush  to  scrub 

7 


8  EVERYDAY  MOUTH  HYGIENE 

the  teeth  and  gums  so  that  they  are  clean.  If  all  the 
teeth  can  be  kept  as  clean  as  shown  in  Fig.  1,  decay 
will  not  occur,  gum  infection  will  be  prevented,  and  the 
chances  against  rheumatism,  heart  disease,  ulcer  of  the 


Fig.  1. — Shows  two  normal  clean  teeth.  The  line  A 
represents  the  gum  margin;  the  shading,  the  bony  sockets 
supporting  the  teeth  in  the  jaw. 

stomach,  and  many  other  fatal  diseases  will  be  reduced 
50  per  cent. 

Figure  2  represents  similar  teeth  in  another  child 
aged  ten,  where  efficient  cleansing  has  not  been  per- 
formed. The  mass  of  small  worm-like  lines  around 
the  gum  margins  and  the  space  between  the  teeth,  rep- 


EVERYDAY  MOUTH  HYGIENE  9 

resents  the  disease-spreading  infection  covering  the 
gums  that  are  now  outlined  by  a  dotted  line.  This 
mass  at  the  exposed  sides  of  the  teeth  can  be  cleansed 
by  the  brush,  but  the  mass  at  B,  between  the  teeth,  can 


Fig.  2. — Shows  the  same  teeth  as  in  Fig.  1,  except  that 
they  are  dirty  through  lack  of  proper  cleansing.  The  little 
worm-like  lines  represent  the  infection.  Note  the  mass  of 
bacteria  in  the  space  B  that  can  only  be  cleansed  by  the  dental 
floss. 

only  be  cleansed  by  dental  silk,  and  unless  dental  silk 
is  used  daily  and  unless  a  small  brush  skilfully  used 
scrubs  the  necks  of  the  teeth  clean  each  day,  the  gums 
and  bone  will  be  progressively  diseased  as  is  sho^vn  by 
the  following  series  of  illustrations. 


10 


EVERYDAY  MOUTH  HYGIENE 


Figure  3  illustrates  the  condition  of  the  gum  and 
bone  between  and  around  the  teeth  at  approximately 
the  age  of  fifteen  years  when  the  infection  between  the 
teeth  has  been  growing  undisturbed  for  at  least  five 
years.     This  is  the  critical  time  for  the  health  of  the 


Fig.  3. — The  beginning  of  a  pyorrhea  pocket  starting  be- 
tween the  teeth.  Note  the  absorption  of  the  bone  at  the 
bottom  of  the  space  B. 


child's  teeth  and  gums.  Even  yet,  if  the  dental  floss 
is  ruthlessly  swept  along  the  triangle  B^  the  space  be- 
tween the  teeth  can  be  restored  to  health.  The  gums 
by  this  time  are  swollen  and  red,  while  the  slightest 
touch  to  the  tissue  between  the  teeth  will  cause  pain 


EVERYDAY  MOUTH  HYGIENE  11 

and  a  free  flow  of  blood.  The  absorption  and  roughness 
of  the  bone  between  the  teeth  show  the  beginning  of  the 
infected  spot  that  is  to  grow  into  a  pyorrhea  pocket. 

The  curative  action  of  the  dental  floss  is  twofold :  It 
mechanically  removes  the  mass  of  infection,  and  it  rubs 
the  germs  into  the  gums  so  that  the  tissues  are  stimu- 
lated to  form  a  protective  ferment  that  will  destroy  any 
individual  germ  that  attempts  further  advance,  and  at 
the  same  time  the  ferment  increases  the  resistance  of  the 
gums  to  any  further  infecting  attack.  In  plain  words, 
it  vaccinates  the  gums. 

Of  course  some  infections  are  much  more  aggressive 
and  poisonous  than  others,  and  therefore  this  crisis 
may  come  much  more  quickly  to  some  teeth  than  others ; 
it  may  come  as  early  as  twelve  or  as  late  as  twenty- 
five  years  of  age,  just  as  there  is  or  is  not  protect- 
ive action  of  the  saliva  or  of  the  tissues.  When  the 
infection  has  really  become  intrenched  in  the  substance 
of  the  gum  and  bone,  as  in  the  triangle  B,  it  penetrates 
with  great  rapidity  along  the  roots.  This  makes  the 
much-talked  of  pyorrhea  pocket.  The  gums  on  the 
sides  being  partly  swept  by  the  food,  recede  more 
slowly,  so  that  external  observation  may  reveal  the 
gums  at  almost  their  normal  size,  while  deep  pockets 
may  have  formed  as  shown  in  Fig.  4. 

Figure  4  is  now  drawn  as  a  cross-section  with  the 
outer  bony  plate  removed  from  the  roots.  Thus  we 
can  see  the  progress  of  the  pocket  beneath  the  gum  as 
revealed  by  the  area  of  little  worm-like  lines  that  even 


12 


EVERYDAY  MOUTH  HYGIENE 


now  have  dissolved  the  bone  and  have  worked  along 
the  root  membrane  of  the  molar,  so  that  the  nerve  is 
beginning  to  be  infected.  There  may  be  no  decay 
in  the  crown  of  the  tooth,  and  externally  the  tooth 
may  appear  quite  normal  except  for  a  slight  tender- 


Fig.  4. — The  further  progress  of  the  pyorrhea  pocket 
which  is  now  well  established.  The  picture  shows  the  cross- 
section  of  the  teeth  and  gum.  The  outer  bony  plate  has  been 
removed,  showing  the  bone  only  on  the  side. 


ness  to  pressure  and  an  extra  sensibility  to  heat  or  cold. 
Such  a  pocket  may  form  here  and  there  in  the  mouth 
where  the  infection  has  found  exceptional  opportunity 
for  growth,  while  the  gums  on  either  side  of  the  pocket 
may  be  as  high  as  the  gums  shown  on  the  outer  sides 


EVERYDAY  MOUTH  HYGIENE 


13 


of  the  teeth  in  Fig.  4.  Such  a  pocket  appears  be- 
tween the  ages  of  twenty-five  and  forty  years,  and  can 
only  be  cured  by  radical  surgery  and  long  treatment. 
But  all  of  this  destruction  and  toxic  poisoning  could 


Fig,  5. — A  fully  established  pyorrhea  pocket  with  an 
abscess  at  the  tip  of  the  molar.  The  black  spot  represents 
the  abscess. 


have  been  prevented  by  the  skilful  daily  use  of  the  tooth 
silk  and  brush.  The  destructive  enlargement  of  the 
pocket  from  now  on  is  extremely  rapid,  as  is  shown  in 
Fig.  5. 

The  bone  around  the  tip  of  the  adjacent  molar  root  is 


14  EVERYDAY  MOUTH  HYGIENE 

completely  diseased  and  is  replaced  by  a  spongy  mass 
of  infection.  The  germs  have  penetrated  the  tip  of  the 
molar  root,  destroying  that  portion  of  the  nerve  and 
causing  the  acute  abscess  sac  to  form,  as  is  shown  by 
the  black  spot.  Thus  we  have  a  dead  nerve  in  one  root 
while  the  nerve  in  the  other  root  is  alive.  The  tooth  is 
painful  and  loose.  Each  time  the  tooth  is  used  in 
chewing  food  the  infected  root  is  jammed  on  the  spongy 
infection  beneath,  so  that  the  poison  and  germs  are 
driven  into  the  bone  substance,  where  the  circula- 
tion carries  them  to  all  portions  of  the  body  to  lodge  and 
form  new  areas  of  infection. 

Those  portions  of  the  body  that  have  the  weakest 
resistance  receive  this  injected  material,  whether  it  be 
the  joints,  the  heart,  the  stomach,  the  nerve  centers, 
or  the  liver,  and  thus  a  tooth  externally  undecayed  and 
apparently  normal  in  appearance  may  be  the  cause  of  a 
crippling  disease,  and  all  because  the  teeth  were  not 
cleansed  for  a  period  of  five  minutes  once  or  twice  a  day. 
It  will  be  noted  in  Fig.  5  that  the  worm-like  hnes  of 
infection  have  almost  reached  the  tip  of  the  other  tooth. 

Figure  6  shows  a  further  progressive  stage.  One 
root  of  the  molar  has  become  absorbed  and  roughened 
with  sharp,  needle-like  points,  while  abscess  sacs  have 
formed  on  the  other  two  roots,  so  that  all  three  of  the 
roots  during  the  process  of  chewing  now  act  like  pistons 
of  a  syringe,  forcing  the  infection  into  the  blood-stream. 
At  first  the  body  resists  the  poison,  but  as  it  is  driven  in 
day  by  day,  week  by  week,  year  by  year,  the  systemic 


EVERYDAY  MOUTH  HYGIENE 


15 


health  resistance  is  broken  down,  and  the  patient  be- 
comes permanently  diseased.  Such  teeth  at  first  may 
be  sore  or  sensitive  to  cold  or  heat,  but  as  the  disease 
becomes  chronic  the  pain  disappears  and  the  teeth 
seem  almost  normal  in  their  functions.     The  greatest 


Fig,  6. — A  pocket  that  is  spreading  Infection  to  the  other  teeth. 

infection  may  come  from  a  tooth  that  has  become  ab- 
scessed and  apparently  recovered,  since  the  fact  that  a 
tooth  is  comfortable,  normal  in  appearance,  and  useful 
for  chewing  food  is  no  guarantee  that  it  may  not 
be  the  spreader  of  infection,  which  within  a  compara- 


; 


16  EVERYDAY  MOUTH  HYGIENE 

tively  short  time  will   cause  crippling  neuralgias  or 
death-dealing  abscesses  in  the  vital  organs  of  the  body. 


Fig.  7, — Teeth  that  have  never  been  properly  cleansed. 

Figure  7  shows  the  mouth  of  a  woman  who  did  not 
cleanse  her  teeth  and  gums,  and  Fig.  8  shows  the  de- 
formity of  her  hand  which  was  typical  of  a  disease 


EVERYDAY  MOUTH  HYGIENE 


17 


that  resulted  in  her  becoming  a  complete  cripple  and 
led  eventually  to  her  death. 

Let  us  again  remember  that  this  terrible  source  of 
disease  would  be  eliminated  by  proper  mouth  cleansing. 
We  have  seen  how  the  deadly  pus  pocket  can  form  in 


Fig.  8. — Deformity  due  to  unclean  teeth. 


the  jaw  bone  when  there  is  no  tooth  decay;  let  us  now 
examine  how  the  same  type  of  bone  abscess  can  be 
formed  by  decay  in  the  crown  of  the  tooth. 

Figure  9  shows  two  such  cavities  forming. 

Figure  10  shows  a  further  progress  of  infection  w^here 
the  nerve  is  reached. 


18  EVERYDAY  MOUTH  HYGIENE 

Figure  1 1  shows  a  putrescent  nerve  with  the  same  t3^e 
of  bone  abscess  at  the  root  tip  as  we  have  aheady  seen 
in  Figs.  5  and  6. 

CleanHness  would  have  prevented  all  of  this  trouble. 
If  the  space  between  the  teeth  had  been  kept  clean  the 
cavity  on  the  side  of  the  tooth  would  not  have  oc- 


Fig.  9. — Spots  of  tooth  decay  due  to  lack  of  cleanliness. 

curred,  and  if  the  fissure  on  the  crown  of  the  tooth 
had  been  polished  by  the  dentist  so  that  food  could  not 
jam  into  it,  the  grinding  surface  would  have  been  self- 
cleansing;  thus  the  cavities  would  not  have  formed  and 
the  infection-spreading  bone  abscesses  at  the  tips  of  the 
roots  would  have  been  prevented. 


EVERYDAY  MOUTH  HYGIENE  19 

Thus  we  see  how  easy  it  is  for  a  dentist  and  a  patient 
to  prevent  decay  before  it  starts,  and  how  difficult,  and 
finally  how  impossible,  it  is  to  remedy  the  trouble  except 
by  the  extraction  of  the  teeth  and  the  scraping  away  of 
the  diseased  jaw  bone.     This  warns  us  not  only  to  see 


Fig.  10. — Tooth  decay  advanced  to  the  point  of  nerve  infection. 

that  our  teeth  and  gums  are  kept  clean,  it  also  urges  us 
to  visit  the  dentist  so  that  any  defects  of  tooth  develop- 
ment may  be  remedied.  For  when  that  is  done  skil- 
fully and  the  teeth  have  erupted  so  that  they  can  be 
kept  clean,  thorough  cleansing  of  the  teeth  and  gums 


20  EVERYDAY  MOUTH  HYGIENE 

with  brush  and  tooth  silk  will  prevent  mouth  infection 
with  all  of  its  consequent  systemic  diseases. 

Let  us  now  consider  the  proper  method  of  cleansing 
the  teeth  and  gums:    In  a  large  majority  of  cases  the 


Fig.  11. — Tooth  decay  that  has  attacked  the  dental  nerve 
and  formed  an  infection-spreading  bone  abscess  at  the  root- 
tip. 

pyorrhea  pocket  of  infection  starts  between  the  teeth, 
and  as  the  tooth  silk  alone  can  cleanse  the  tooth  spaces, 
the  efficient  use  of  this  important  and  much  neglected 
agent  of  mouth  hygiene  will  now  be  discussed. 


EVERYDAY  MOUTH  HYGIENE 


21 


Figure  12  shows  the  space  between  the  teeth  packed 
with  a  bacterial  mass  that  is  ahvays  present  if  the  dental 
silk  is  not  used  properly.  Dental  silk  heretofore  has 
been  supposed  to  be  used  solely  for  the  purpose  of  re- 
moving particles  of  food  from  between  the  teeth,  and 


Fig.  12. — The  small  worm-like  lines  indicate  the  mass 
of  infection  usually  found  around  or  between  the  teeth  un- 
less dental  floss  and  a  small  tooth-brush  have  been  properly 
used. 


while  this  is  unquestionably  important,  it  is  far  more 
important  that  the  mass  of  bacteria  shall  be  thoroughly 
removed  before  it  can  gain  lodgment  in  the  teeth  and 
the  gum.  But  because  the  dental  silk  has  been  used 
solely  with  the  idea  of  removing  food  particles,  where 
food  did  not  pack  between  the  teeth  the  dental  silk  has 


22 


EVERYDAY  MOUTH  HYGIENE 


not  been  used  at  all,  and  where  it  has  been  used  it  has 
been  slipped  in  and  out  in  a  straight  line  to  the  gum, 
making  only  a  cut  in  the  bacterial  mass  as  in  Fig.  13, 
leaving  the  gum  and  tooth  surface  as  much  covered  as 
before  it  was  used.  The  silk  when  used  should  extend 
well  around  the  contours  of  the  tooth  surface  (see  Fig. 


Fig.  13. — Bacterial  mass  between  the  teeth  cut  but  not  re- 
moved by  the  wrong  way  of  using  the  dental  floss. 


14) .  for  the  bacteria  are  very  adhesive  and  stick  to  the 
infected  tooth  and  gum  surfaces  with  all  the  tenacity  of 
glue.  No  mouth-wash  can  kill  or  remove  a  mass  of 
bacteria.  It  is,  therefore,  essential  that  the  dental  silk 
should  be  scraped  along  the  rounded  contours  of  the 
three  sides  of  the  triangular  space  between  the  teeth. 


EVERYDAY  MOUTH  HYGIENE 


23 


so  that  only  the  slightest  film  of  bacteria  will  be  left. 
The  mass  of  bacteria  will  come  out  on  the  tooth  silk. 
It  is  particularly  important  that  the  mass  of  infection 
should  be  thoroughly  removed  from  around  the  curv- 
ing sides  of  the  tooth  so  that  the  tooth-brush  can  readily 


Fig.  14. — Shows  the  way  the  dental  floss  should  extend 
around  the  contours  of  the  teeth  during  the  process  of  cleans- 
ing. 


remove  all  of  the  remaining  film,  and  so  render  the 
mouth  free  from  masses  of  bacteria,  for  a  thin  film 
of  germs  cannot  produce  an  amount  of  poison  or  acid 
sufficient  to  harm  either  the  gums  or  the  teeth. 
Figure  15  shows  the  space  cleaned  by  the  removal  of 


24 


EVERYDAY  MOUTH  HYGIENE 


the  mass  through  its  adherence  to  the  dental  silk.  It 
will  be  noted  that  at  the  sides  of  the  teeth  near  the  gum 
a  considerable  portion  of  the  germ  deposit  has  been 
scraped  away  by  the  encompassing  sweep  of  the  silk. 
To  make  it  quite  simple,  let  the  triangle,  Fig.  16,  rep- 
resent the  space  between  the  teeth.    The  lines  A-B  and 


Fig,  15. — The  extent  of  cleansing  that  properly  used  dental 

floss  can  effect. 


A-C  represent  the  sides  of  the  teeth.  The  line  B-C 
represents  the  gum  line  between  the  teeth.  The  dental 
silk  should  start  at  the  grinding  surface  A ,  scrape  down 
to  Bf  then  scrape  from  B  to  C,  and  finally  from  C  to 
A,  and  out,  carrying  the  bacteria  away  on  the  silk. 
Properly  used,  the  dental  silk  is  far  more  important 


EVERYDAY  MOUTH  HYGIENE  25 

as  a  means  of  cleansing  and  preserving  the  teeth  and 
gums  than  the  tooth-brush.  When  this  use  of  the 
dental  silk  has  been  performed  on  all  the  tooth  spaces, 
and  especially  on  the  gum  margins  back  of  the  back 
teeth,  three-fourths  of  the  bacterial  mass  in  the  mouth 
will  have  been  removed,  and  the  remainder  can  readily 
be  cleansed  by  a  small  brush  properly  used. 


Fig.  16. — A  diagrammatic  representation  of  the  space  be- 
tween the  teeth.  The  arrows  indicate  the  path  which  should 
be  followed  b}'  the  dental  floss. 

Let  US  now  take  up  the  handling  of  the  dental 
floss  with  the  fingers  in  detail,  so  as  to  readily  and 
efi'ectively  reach  all  portions  of  the  mouth.  Many 
instruments  for  holding  dental  floss  have  been  devised, 
but  there  is  no  instrument  equal  to  the  finger-tips  prop- 
erly instructed  and  used.  In  fact,  the  finger-tips  are 
the  only  instruments  up  to  the  present  time  that  have 
accomplished  this  function  satisfactorily.     And  they 


26  EVERYDAY  MOUTH  HYGIENE 

require  the  most  careful  training  if  the  bacterial  films 
are  to  be  effectively  removed. 


Fig.  17. — Preliminary  position  of  the  dental  floss. 

Figure  17  shows  the  first  position  taken  for  holding 
the  dental  floss.  The  piece  of  silk  should  not  be  less 
than  18  inches  long  and  the  ends  should  first  of  all  be 


EVERYDAY  MOUTH  HYGIENE  27 

twined  around  the  little  fingers  of  each  hand,  leaving  a 
space  as  shown  in  the  picture  of  about  ^  inch  between 


Fig.  18. — Position  of  floss  for  cleansing  the  left  upper  side  of 

the  mouth. 

the  ends  of  the  thumbs.  Then  for  cleansing  the  teeth 
on  the  upper  left  side  the  dental  silk  should  be  taken 
thus,  Fig.  18,  with  only  |-  inch  of  silk  span  being  left 


28  EVERYDAY  MOUTH  HYGIENE 

between  the  left  thumb  and  right  first  finger.     If  more 
free  silk  is  left  the  cramped  position  in  the  mouth  will 


Fig.  19. — The  position  of  the  floss  when  inserted  in  the 
mouth  for  cleansing  the  left  upper  side.  Note  that  the  thumb 
is  well  inside  the  cheek. 

cause  the  silk  to  slacken  and  pivot,  so  that  the  scraping, 
cleansing  action  will  be  lost.     Then,  as  in  Fig.  19,  slip- 


EVERYDAY   MOUTH  HYGIENE  29 

ping  the  thumb  and  finger-tip  well  within  the  corner 
of  the  mouth,  the  thread  should  be  passed  back  of  the 


Fig.  20, — The  incorrect  wa^^  of  inserting  the  silk. 

third  molar  and  well  up  into  the  fold  of  the  gum  around 
it,  and  the  gum  and  tooth  surface  should  be  well  scraped 
of  its  slimy  covering.   Figure  20  shows  the  incorrect  way. 


30  EVERYDAY  MOUTH  HYGIENE 

where  the  cheek  is  pushed  back  by  the  thumb,  making 
it  most  difficult  to  reach  the  back  teeth.     The  silk  should 


Fig.  21. — Further  progress  in  the  cleansing  of  the  left  upper 

teeth. 


then  be  passed  into  the  next  space  and  continued  for- 
ward (see  Fig.  21),  the  triangular  motion  previously 


EVERYDAY  MOUTH  HYGIENE  31 

described  being  carried  out.     When  the  central  division 
of  the  teeth  has  been  reached,  the  silk  should  be  shifted 


Fig.  22. — Position  of  floss  for  cleansing  the  right  upper  side 

of  the  mouth. 


as  in  Fig.  22,  for  the  work  on  the  upper  right  side,  and 
inserted  as  in  Fig.  23.     Note  that  the  right  thumb  must 


32 


EVERYDAY  MOUTH  HYGIENE 


be  on  the  outside  of  the  dental  arch  for  the  right  side 
cleansing,  just  as  the  left  thumb  should  be  on  the  outside 


Fig.  23. — Position  of  fingers  for  cleansing  the  right  upper  back 

teeth. 


of  the  dental  arch  for  cleansing  the  left  upper  teeth. 
Then,  as  was  done  on  the  left  side  of  the  cheek,  the  right 


EVERYDAY  MOUTH  HYGIENE  33 

side  is  pushed  out  by  the  right  thumb,  the  silk  inserted 
back  of  the  right  third  molar,  and  the  procedure  re- 
peated until  the  upper  front  teeth  are  again  reached. 


-    Fig.  24. — Position  of  silk  for  cleansing  the  lower  teeth. 

For  starting  to  cleanse  the  lower  right  teeth  the  dental 
silk  should  be  supported  by  the  tips  of  the  two  index- 


34  EVERYDAY  MOUTH  HYGIENE 

fingers  (see  Fig.  24),  and  then,  as  in  Figs.  25,  26,  and  27, 
the  silk  should  be  passed  back  of  the  lower  third  molar 


Fig.  25. — Position  for  cleansing  the  right  lower  back  teeth. 

on  the  right  side,  well  down  into  the  fold  of  the  gum,  and 
the  bacteria  scraped  out  from  between  the  teeth  as 
previously  described.    The  triangular  motion  should 


EVERYDAY  MOUTH  HYGIENE  35 

invariably  be  carried  out  in  all  the  dental  spaces  to  the 
front  middle  section.     The  silk  should  then  be  passed 


Fig.  26. — Note  the  curve  of  the  silk  when  cleansing  the  back 

of  a  tooth. 

back  of  the  left  lower  third  molar,  and  the  process  re- 
peated on  that  side.  (See  Figs.  28  and  29.)  Note  again 
in  cleansing  the  right  lower  teeth  the  right  index-finger 


36  EVERYDAY  MOUTH  HYGIENE 

is  always  on  the  outside,  and  with  the  left  teeth  the  left 
index-finger  is  always  on  the  outside. 


Fig.  27. — Note  the  curve  of  the  silk  when  cleansing  the  front 
surface  of  a  tooth. 

This  is  not  an  easy  performance  to  execute  efficiently 
so  that  the  deposits  will  be  thoroughly  removed.  The 
gums  will  bleed  at  first  and  will  be  sore  for  a  period  of 


EVERYDAY  MOUTH  HYGIENE  37 

ten  days  to  two  weeks,  but  a  trial  of  this  procedure  dur- 
ing the  time  mentioned  will  give  a  feeling  of  cleanliness 


Fig.  28. — Cleansing  the  spaces  between  the  left  lower  teeth. 

never  before  experienced,  and  the  gums,  ceasing  to  bleed, 
will  become  pink,  firm,  and  comfortable. 

Let  us  now  consider  the  use  of  the  tooth-brush  as  a 


38  EVERYDAY  MOUTH  HYGIENE 

means  of  removing  the  bacterial  masses  from  the  ex- 
posed surfaces  of  the  teeth  and  the  gums.     Just  as  those 


Fig.  29. — Finish  of  cleansing  the  spaces  between  the  left  lower 

teeth. 

who  never  use  dental  silk  never  cleanse  between  the 
teeth,  so  do  the  great  majority  of  those  who  brush  the 
teeth  never  really  cleanse  them.     The  cleansing  action 


EVERYDAY  MOUTH  HYGIENE  39 

of  a  tooth-brush  can  only  lie  in  bristle  friction,and  most 
well-meaning  people  either  use  strokes  of  the  brush  that 
never  get  beyond  a  pivoting  of  the  long  bristles,  or  they 
use  brushes  so  large  that  there  is  neither  room  to  move 
them  nor  to  effectively  place  them  against  the  back 
teeth.  With  all  the  talk  that  there  has  been  about  tooth 
brushing  since  Adam  delved  and  Eve  span,  the  wisdom 
teeth  have  never  been  brushed.  The  dirty,  neglected 
wisdom  tooth  has  been  as  badly  treated  as  the  near- 
sighted child  of  fifty  years  ago  who  was  relegated  to 
the  dunce  cap  because  he  could  not  see  the  letters  of 
the  book  that  he  was  blamed  for  not  understanding. 
The  wisdom-tooth  enamel  is,  in  structure,  just  as  sound 
as  that  of  any  other  tooth,  and  it  has  its  bad  name  simply 
because  it  is  never  cleansed.  And  because  the  back 
molars  are  badly  cleansed  they  are  usually  the  first  to 
become  infected  and  loosen. 

The  great  test  of  a  tooth-brushing  method  is,  does  it 
cleanse  where  it  is  designed  to  cleanse?  In  plain  words, 
the  way  to  brush  the  teeth  and  gums  is  to  brush  them. 
Obviously,  too  large  a  brush  is  useless.  To  use  a  2-inch 
brush  with  bristles  |-inch  long  where  there  is  only  2i 
inches  for  free  action  means  that  there  will  be  practically 
no  bristle  friction,  which  is  what  occurs  in  most  mouths 
during  the  process  of  brushing  the  teeth.  The  usual 
brush  being  about  2  inches  long  generally  reduces  the 
possible  movement  of  the  brush  to  about  i  inch,  and 
this  half-inch  is  entirely  taken  up  by  the  spring  and 
pivoting  of  the  bristles,  so  that  with  any  such  attempt 


40  EVERYDAY  MOUTH  HYGIENE 

at  brushing  there  is  very  Httle  bristle  friction  at  all. 
Therefore  we  should  avoid  the  use  of  the  ordinary  large 
tooth-brush  and  use  a  narrow  bristle  brush  not  over  1| 
inches  long,  with  bristles  not  over  J  inch  in  length. 
This  will  allow  sufficient  room  for  genuine  motion  of 
the  brush  in  the  mouth,  and  if  the  bristles  are  too  stiff, 
the  brush  should  be  placed  in  hot  water  for  a  minute 
each  time  before  using,  until  the  gums  have  become 
accustomed  to  genuine  cleansing.  Healthy  gums  can 
bear  the  same  scrubbing  as  the  flesh  around  the  finger- 
nails, and  with  the  same  benefit.  In  fact,  the  exposed 
surfaces  of  unhealthy  inflamed  gums  when  given  a 
vigorous  scrubbing  with  a  stiff  brush  twice  a  day,  in 
the  course  of  a  week  or  ten  days  will  become  firm  and 
healthy,  and  no  other  single  treatment  will  accomplish 
the  same  result.  This  generally  unknown  fact  was  util- 
ized some  years  ago  by  a  certain  charlatan  who  was 
trying  to  sell  his  tooth-paste.  He  forced  his  way  into 
the  office  and  immediately  began,  "Doctor,  this  tooth- 
paste is  most  useful  for  the  cure  of  the  small  canker 
sores  that  so  often  come  on  the  cheek  and  gums.  All 
you  have  to  do  is  to  put  a  little  of  this  paste  on  the  tooth- 
brush and  brush  it  thoroughly  into  them."  "But,"  I 
interposed,  "won't  the  sores  get  well  if  they  are  brushed 
with  the  tooth-brush  and  water?"  "Why,  yes,"  he 
replied,  with  a  sickly  smile,  "but  that  is  not  usually 
known." 

The  brushing  of  the  gums,  as  before  stated,  is  of 
prime  importance,  but  the  intense  pain  occasioned  by 


EVERYDAY   MOUTH  HYGIENE  41 

the  first  week's  work  is  as  severe  as  the  pains  in  the 
back  of  an  athlete  when  he  first  starts  to  get  himself  into 
condition.  The  trainer  tells  the  athlete  to  go  on  with 
his  work  and  that  it  will  be  all  right,  and  in  the  same 
way  the  poor  patient,  though  he  fears  that  he  is  injuring 
his  gums  when  he  uses  the  brush  vigorously,  must  be 
encouraged  by  his  dentist  to  continue,  with  the  assur- 
ance that  the  pain  in  his  gums  will  soon  disappear. 
The  author  once  showed  a  young  lawyer  how  to  brush 
his  teeth  and  gums.  He  went  away  and  the  next  day 
the  author  received  a  letter  from  him  threatening  suit 
for  having  ruined  his  face.  Amusing  as  this  incident  is, 
it  has  a  very  serious  bearing.  The  gums,  to  be  healthy, 
must  be  scrubbed  so  as  to  remove  the  bacterial  masses, 
and  also  the  dead  epithelial  scale,  which  will  act  as  a 
bacterial  food.  Scrubbing  infected  gums  cannot  result 
at  first  in  anything  but  further  infection,  that  may,  and 
frequently  does,  cause  a  slight  fever,  and  yet  the  bac- 
teria cannot  be  removed  and  the  gums  will  not  heal  un- 
less this  severe  ordeal  is  endured.  The  systemic  reac- 
tions caused  at  times  by  brushing  infected  gums  must 
be  explained  as  a  process  of  vaccination,  for  under  no 
other  supposition  is  it  possible  to  explain  why,  under  the 
newly  inaugurated  thorough  brushing  day  by  day,  the 
gums  should  continue  to  be  sore  and  inflamed,  and  then 
suddenly,  between  the  seventh  and  tenth  day,  become 
healthy,  hard,  and  firm,  thereafter  standing  with  com- 
placency any  amount  of  brushing. 

The  brushing  of  the  teeth  will  now  be  discussed  in 


42  EVERYDAY  MOUTH  HYGIENE 

detail.  As  before  stated,  the  tooth-brush  should  not 
be  over  1 J  inches  long,  the  bristles  not  over  J  inch  long, 
and  the  handle  long  and  large  enough  to  afford  a  firm 
grip  to  the  hand  (Figs.  30,  31).  The  principal  thing  to 
be  avoided  is  too  great  bristle  length,  since  long  bristles, 
by  increasing  the  pivoting  arc  of  each  bristle,  just  so 
much  reduce  the  bristle  friction  produced  by  the  gen- 
eral movement  of  the  brush.     It  is  bristle  friction  alone 


"    lUUUUI 


Fig.  30. — Actual  size  of  brush  that  can  properly  cleanse  the  teeth 

and  gums. 

that  cleanses  the  teeth  and  gums  during  the  process  of 
brushing.  Bristles  J  inch  long  can  pivot  f  inch  each 
way  without  bristle  friction.  If,  therefore,  there  is  a 
1-inch  stroke,  the  bristle  friction  stroke  is  only  J  inch, 
and  if,  as  frequently  happens,  the  tooth-brush  stroke 
is  only  f  inch,  there  is  no  bristle  friction  stroke  at  all. 
The  J-inch  bristle,  under  the  same  conditions,  would 
have  a  play  each  way  of  -^g  inch,  which  theoretically 


EVERYDAY   MOUTH  HYGIENE  43 

would  cause  only  f-inch  loss  of  bristle  friction,  but,  in 
reality,  it  would  be  less,  since  the  further  the  bristle 
extends  from  the  back  of  the  brush,  the  more  readily 
it  bends  under  pressure.  But  granting  that  there  was 
f  inch  loss  in  bristle  friction  to  each  stroke,  this  would 
still  leave  a  real  cleansing  friction  stroke  of  f  inch,  when 


Fig.  31. — Actual  size  of  brush  ordinarily  used. 

the  1^-inch  brush  was  moved  through  a  2  J-inch  stroke^ 
the  amount  of  space  for  tooth-brush  motion  usually 
found  in  the  average  adult  mouth. 

So  much  for  the  mechanics  of  tooth-brushing;  now  as 
to  the  actual  motions  as  applied  to  the  human  mouth. 
There  are  three  motions:     First,  the  rotary  motion^ 


44  EVERYDAY  MOUTH  HYGIENE 

whereby  all  the  gums  and  teeth  anterior  to  the  second 
molars   are   cleansed  with   vigorous  whirling   action; 


Fig.  32. — ^Motion  of  brush  for  cleansing  front  teeth  and  gums. 


second,  the  drawing  motion,  wherein  the  middle  of  the 
brush  is  placed  behind  the  last  molar  and  drawn  vigor- 
ously across  the  outside  gum  margins  of  the  teeth; 


EVERYDAY  MOUTH  HYGIENE  45 

third,  the  drawing  motion,  wherein  the  brush  is  placed 
back  of  the  last  molar  inside  of  the  mouth  and  drawn 
sharply  forward  along  the  gum  margins  and  the  teeth. 
In  each  stroke  care  should  be  used  to  follow  the  curve 
of  the  arch  with  the  entire  face  of  the  brush. 

Let  us  now  discuss  motion  No.  1  in  its  minute  details. 
The  upper  and  lower  front  teeth  should  be  placed  edge 
on  edge  to  avoid  the  lapping  of  the  upper  teeth  over  the 
lower.-  The  brush  should  then  be  placed  against  the 
teeth  and  rubbed  upward  to  the  junction  of  the  upper 
gum  and  lip,  forward  for  a  distance  of  a  full  inch  or  more, 
dow^nward  to  the  lower  gum  and  lip  margin,  then  back 
to  the  original  position,  and  end  with  three  small  inner 
circular  motions  on  the  teeth  as  shown  in  Fig.  32. 
This  should  be  done  at  least  five  or  six  times.  The 
brush  should  then  be  placed  between  the  cheek  and 
teeth  on  the  left  side.  Here  the  same  general  motions 
should  be  carried  out.  The  brush  should  be  rubbed 
upward  to  the  juncture  of  the  cheek  and  gum,  back  to 
w^here  the  end  of  the  brushing  is  stopped  by  the  over- 
hanging curve  of  the  low^er  jaw,  down  to  the  juncture 
of  the  cheek  and  lower  gum,  then  back  to  the  start,  and 
three  circular  motions,  as  in  Fig.  33.  This  same  motion 
should  be  repeated  on  the  right  side  and  the  three  move- 
ments of  motion  No.  1  are  finished.  If,  after  this 
motion  has  been  thoroughly  performed,  the  second  and 
third  molars,  upper  and  lower,  are  examined,  they  will 
still  be  found  covered  wath  bacterial  masses.  And  the 
reason  for  these  undisturbed  deposits  is  easily  discov- 


46  EVERYDAY  MOUTH  HYGIENE 

ered.    The  curving  side  of  the  lower  jaw  Hes  so  close 
to  the  upper  teeth  that  no  tooth-brush  can  effectively 


Fig.  33. — Motion  of  brush  for  cleansing  side  teeth  and  gums. 

get  at  them  while  the  jaws  are  closed,  and  in  the  same 
way  the  last  two  lower  teeth  are  excluded  from  the  ac- 
tion of  the  brush  by  the  fact  that  they  lie  behind  and 


EVERYDAY  MOUTH  HYGIENE  47 

within  the  curving  angle  of  the  lower  jaw.  When  the 
jaws  are  closed  there  is  not  i  inch  of  room  remaining 
for  tooth-brush  cleansing,  but  when  the  jaws  are  partly 
opened,  the  lower  jaw  swings  back,  leaving  a  space  of  a 
full  I  inch  in  which  the  brush  can  thoroughly  do  its 
work  behind  the  third  molars.  Therefore,  as  just  inti- 
mated, in  performing  motion  No.  2  for  the  upper  teeth 
the  mouth  should  be  about  half  open  and  the  lips  and 
cheek  held  relaxed.  The  middle  of  the  bristles  of  the 
1  J-inch  brush  should  be  placed  at  the  back  of  the  third 
molar  and  drawn  briskly  forward  along  the  gum  margins, 
care  being  taken  to  follow  the  curve  of  the  gum  with  the 
entire  face  of  the  brush  (Fig.  34).  To  place  the  brush 
behind  the  third  molar  the  relaxed  corner  of  the  mouth 
should  be  stretched  back  by  the  back  of  the  brush  until 
the  middle  of  the  brush  is  directly  back  of  the  wisdom 
tooth.  When  this  is  done  correctly  the  brush  will  be 
pointing  directly  at  the  wisdom  tooth  on  the  other  side 
of  the  arch.  The  middle  of  the  brush  should  be  placed 
behind  the  third  molar,  not  thrust  in  place  by  the  point, 
as  by  thrusting  the  bristles  will  be  so  bent  that  the 
resulting  pivoting  of  the  bristles  will  cause  the  back  of 
the  upper  third  molar  to  get  no  bristle  friction  at  all, 
and  so  the  back  of  the  third  molars  will  not  be  cleansed. 
Motion  No.  2  in  its  action  on  the  lower  molar  teeth  is 
exactly  the  same  as  with  the  upper,  except  that  instead 
of  placing  the  bristles  on  the  back  of  the  lower  third 
molar,  the  bristles  are  directed  downward  on  the  gum 
back  of  the  third  molar,  and  then  with  a  curving,  down- 


48  EVERYDAY  MOUTH  HYGIENE 

ward  sweep  are  brought  sharply  along  the  gum  and  cheek 


Fig.  34. — Position  of  brush  preparatory  to  cleansing  upper  wis- 
dom teeth.  Dotted  line  shows  direction  in  which  the  brush  should 
be  drawn. 


margins  and  the  necks  of  the  lower  teeth  (Fig. '35). 
This  motion  should  be  carried  out  on  the  upper  and 


EVERYDAY  MOUTH  HYGIENE 


49 


lower  ja\YS,  right  and  left,  and  not  less  than  five  or  six 
times  each. 


Fig.  35. — Position  of  brush  preparator}^  to  cleansing  back  of 
lower  wisdom  teeth.  Dotted  line  shows  the  proper  downward 
sweep. 


Motion  No.  3  is  comparatively  simple.     The  brush 
is  placed  on  the  gum  and  tooth  line  behind  the  third 


50  EVERYDAY  MOUTH  HYGIENE 

molars  and  drawn  sharply  forward  and  out  of  the  mouth 
over  the  insides  of  the  central  incisors,  care  being  taken 
to  follow  the  curve  of  the  arch  with  the  entire  face  of 
the  brush.  The  brush  should  be  placed  so  as  to  extend 
back  of  the. last  molars,  it  should  not  be  thrust  back  of 
them,  as  the  thrusting  will  cause  a  counterbending  of 
the  brush  bristles  and  result  in  a  pivoting  that  again 
will  leave  the  back  molars  without  bristle  friction,  and 
consequently  dirty  (Fig.  36).  Motion  No.  3  should  be 
done  five  times  on  the  upper  and  lower  jaws,  right  and 
left,  and  when  this  has  been  properly  done  the  sur- 
faces of  the  teeth  and  gums  will  be  free  from  bacterial 
masses. 

After  so  much  minute  explanation  it  may  not  be  in- 
advisable to  review  once  more  just  what  the  daily 
cleansing  of  the  mouth  should  be.  The  surfaces  be- 
tween the  teeth  should  be  thoroughly  swept  by  dental 
floss  to  remove  all  food  and  bacterial  deposits.  The 
teeth  and  gums  should  then  be  thoroughly  brushed,  as 
described,  with  dentifrice  or  antiseptic  mouth-wash, 
and  the  saliva  and  mouth-wash  vigorously  swashed  in 
between  the  teeth  for  a  period  of  not  less  than  two  min- 
utes, so  that  the  thin  coating  of  bacterial  film  left  by 
the  dental  floss  on  the  sides  of  the  teeth  may  be  dis- 
couraged from  growth  until  the  next  cleansing.  Where 
there  is  marked  gum  infection  a  saturated  solution  of 
sodium  silicofluorid  or  1  per  cent,  peroxid  solution  should 
be  held  in  the  mouth  for  at  least  two  minutes  after  the 
procedure  just  described.     This  cleansing  should  be 


EVERYDAY  MOUTH  HYGIENE  51 


Fig.  36. — Position  of  brusti  preparatory  to  cleansing  inside  of 
dental  arches.  The  brush  must  extend  well  back  of  the  back  tooth 
and  be  dra\\Ti  briskl}^  forward  along  the  edge  of  the  gum  and  teeth, 
and  finally  out  across  the  median  line,  as  is  sho'^Ti  by  the  dotted 
line. 


52  EVERYDAY  MOUTH  HYGIENE 

carried  out  morning  and  evening.  It  must  not  be  for- 
gotten, however,  that  each  mouth  is  a  separate  problem 
and  must  be  treated  as  such.  If  teeth  are  missing,  the 
brush  must  be  inserted  vigorously  in  the  vacant  spaces, 
and  if  certain  abnormal  rotations  are  necessary  the 
dentist  must  train  the  patient  to  see  that  these  abnor- 
malities are  met  and  the  parts  are  thoroughly  cleansed 
by  especially  devised  strokes  of  the  brush. 

The  following  is  the  history  of  a  pronounced  case  of 
mouth  infection.  An  examination  revealed  the  fact 
that  the  infection  was  superficial  in  the  gum  and 
had  not  penetrated  along  the  teeth  so  as  to  be  beyond 
the  reach  of  the  dental  floss  and  tooth-brush.  A  sys- 
temic examination  proved  the  patient  to  be  in  good 
general  health.  The  patient  was  accordingly  told 
that  if  he  would  scrub  his  teeth  and  gums  according 
to  the  author's  directions,  and  also  use  dental  floss  as 
described,  he  could  cure  himself  without  any  other 
treatment.  The  patient  came  back  in  four  days. 
There  was  a  wonderful  change  in  color,  showing  that 
the  gums  had  become  almost  normal.  He  was  told 
to  keep  up  the  flossing  and  gum-brushing,  and  not  to 
use  any  dentifrice  or  mouth-wash.  He  came  back  in  a 
week,  and  while  his  mouth  showed  considerable  improve- 
ment, there  was  a  large  ulcer  still  present.  The  author 
told  him  that  by  this  time  he  expected  the  mouth  to  be 
entirely  well.  He  said,  "I  don't  know  what  more  I 
can  do,  doctor,  for  I  brush  my  gums  thoroughly  three 
times  a  day."     "Brush  them  once  a  day,"  was  the 


EVERYDAY  MOUTH  HYGIENE  53 

reply,  "and  give  the  poor  ulcer  a  chance  to  get  well." 
In  this  instance  the  patient  had  been  overstrenuous  in 
carrying  out  instructions.  He  went  away,  and  when, 
after  four  days,  he  returned  his  mouth  looked  and 
felt  entirely  normal.  When  the  author  first  saw  the 
patient,  two  weeks  before,  his  gums  were  dark  red, 
and  would  bleed  at  the  touch  of  dental  floss  or  a 
brush.  Tw^o  weeks  later,  merely  through  proper 
cleansing,  he  could  brush  them  as  vigorously  and  as 
painlessly  as  he  could  brush  his  finger-nails.  There 
was  no  bleeding,  his  mouth  was  healthy,  and  it  not  only 
looked  clean,  but  it  felt  clean.  Mouth  antiseptics  and 
dentifrices  have  unquestionable  value  at  times,  but  for 
ordinary  service  their  value  is  inconsiderable  when  com- 
pared to  efficient  cleansing. 

In  summing  up  it  might  be  wise  to  emphasize  the 
fact  that  a  brush  softened  in  hot  water  is  a  valuable  in- 
strument with  which  to  commence  to  cleanse  and  harden 
infected  gums.  As  the  gums  become  hard  and  firm  the 
patient  will  naturally  be  less  careful  about  the  use  of 
hot  water  on  the  brush  and  very  soon  the  stiff  bristles 
can  be  fearlessly  used.  This  precaution  is  especially 
valuable  in  the  preliminary  training  of  children  in  their 
daily  mouth  hygiene. 

When  green  stains  come  on  the  teeth  and  the  ordinary 
brushing  will  not  remove  them,  a  drop  or  two  of  tincture 
of  iodin  on  a  wet  brush  will  usually  prove  efficacious. 
A  drop  or  two  of  aromatic  spirits  of  ammonia  on  the 
brush  immediately  after  the  iodin  has  been  used  will  re- 


54  EVERYDAY  MOUTH  HYGIENE 

move  any  remaining  dark  stains  and  will  heighten  the 
bleaching  effect.  This  may  also  be  followed  by  a  rinsing 
of  a  1  per  cent,  peroxid  solution.  The  iodin  can  be 
used  two  or  three  days  in  succession,  and  for  a  child 
of  six  years  of  age  can  be  repeated  as  often  as  twice 
a  week.  For  an  adult  the  iodin  can  be  used  every 
day,  especially  if  the  iodin  is  not  swallowed.  Where 
the  previous  directions  have  been  followed  such  iodin 
applications  will  be  quite  sufficient  to  keep  the  mouth 
clean. 

Tooth  pastes  and  powders  have  not  been  accentuated, 
as  ordinarily  they  contain  precipitated  chalk  as  a  basis, 
and  the  chalk  when  used  in  any  quantity  for  any  length 
of  time  cuts  the  enamel,  so  that  in  the  course  of  twenty 
or  thirty  years  the  enamel  is  worn  away,  leaving  the 
tooth  bone  exposed  to  the  saliva.  Liquids  or  a  powder 
that  is  extremely  soluble  are,  therefore,  to  be  preferred. 
Of  these,  table  salt,  for  those  who  do  not  object  to  the 
taste,  is  most  admirable.  It  can  be  sprinkled  on  the 
brush  and  swashed  in  between  the  teeth  after  the  cleans- 
ing has  been  completed.  As  above  stated,  a  solution  of 
1  per  cent,  peroxid  of  hydrogen  is  most  effective  after 
the  bacterial  masses  have  been  removed.  Perborate 
of  soda  is  also  excellent.  It  can  be  flavored  with  winter- 
green  and  makes  an  agreeable  antiseptic  froth  that  gives 
out  large  quantities  of  free  oxygen,  and  in  the  presence 
of  acid  secretions  makes  an  alkahne  peroxid  of  hydrogen 
mixture  that  is  highly  pleasing  and  beneficial. 

For  those  who  really  desire  a  dentifrice  the  following 


EVERYDAY  MOUTH  HYGIENE  55 

formula  is  most  agreeable,  and  practically  non-corrosive, 
being  free  from  chalk: 

Peroxid  of  magnesia 60  parts. 

Perborate  of  soda 30      " 

Pulverized  soap 10      " 

Mix  thoroughly  in  200  mesh  sieve  and  flavor  to  taste. 


REMARKS    ON    IRREGULARITY  IN  CHIL- 
DREN'S  TEETH 

During  the  last  twenty  years  the  straightening  of 
children's  teeth  has  undergone  a  great  revolution  and 
has  developed  from  a  haphazard,  hit-or-miss  procedure 
to  a  delightfully  scientific  method  that  produces  perma- 
nent results  in  a  surprisingly  large  percentage  of  cases. 
But  as  these  permanent  results  should  ordinarily  be 
remedied  between  the  ages  of  sk  and  twelve  years  of 
age,  it  would  be  perhaps  useful  to  point  out  a  few  of  the 
obvious  defects  in  order  that  they  may  be  remedied  as 
soon  as  they  appear. 

It  has  been  discovered  that  the  teeth  do  not  grow  to 
fit  the  face,  but  the  face  grows  to  fit  the  teeth.  If  the 
teeth  can  be  made  to  assume  their  true,  normal  arch, 
the  rest  of  the  face  develops  in  corresponding  sym- 
metry and  beauty.  The  arch  of  the  teeth  is  the  key- 
stone on  which  the  development  of  the  upper  bones  of 
the  face  and  forehead  depend.  If  the  arch  is  constricted 
the  openings  in  the  nose  are  correspondingly  lessened 
or  even  closed.  This  prevents  breathing  through  the 
nose.  The  passage  of  air  through  the  nose  being  cut  off, 
air  pressure  is  not  exerted  ui  the  various  hollow  bones 
of  the  face,  and  thus,  to  a  serious  extent,  this  important 
stimulant  to  facial  development  is  missing.     This  being 

57 


58  EVERYDAY  MOUTH  HYGIENE 

the  case,  it  is  quite  apparent  that  the  future  health  and 
development  of  the  child  depend  largely  on  the  early 
formation  of  a  normal  dental  arch,  and  it  is,  therefore, 
important  for  the  mother  or  nurse  to  be  acquainted  with 
the  first  tendencies  toward  malformation.  When  it  is 
realized  that  before  a  child  is  six  or  seven  years  old 
all  of  the  full-sized  crowns  of  the  permanent  teeth,  ex- 
cept the  wisdom  teeth,  are  packed  away  in  the  small 
face;  and  then  without  disturbing  mastication  or  nutri- 
tion, the  roots  of  the  first  teeth  must  be  absorbed,  and 
the  large  replacing  second  teeth  must  emerge  into  grace- 
ful lines  from  their  crowded  positions  as  the  face  devel- 
ops sufficient  room  for  them,  the  marvel  of  it  is  simply 
overwhelming.  Having  grasped  the  idea  that  the  proc- 
ess of  dentition  is  a  wonderful  engineering  plan,  it  can 
then  be  appreciated  that  a  little  extra  resistance  of  the 
bone  caused  by  inflammation  may  readily  result  in 
producing  serious  disarrangement  and  discord. 

Therefore  it  is  especially  important  that  the  first  teeth 
should  be  kept  clean  and  free  from  decay.  This  should 
be  carefully  looked  to  after  the  fourth  year  has  been 
reached,  and  dental  floss  should  be  slipped  between  the 
first  and  second  temporary  molars  at  least  once  a  day. 
The  small  baby  brush  will  keep  the  rest  of  the  teeth 
clean,  as  the  first  teeth  with  the  exception  of  the 
molars  rapidly  separate  during  the  development  of  the 
jaw,  causing  large  spaces  into  which  the  tooth-brush 
bristles  can  be  easily  inserted  with  a  cleansing  effect. 

In  addition  to  keeping  the  teeth  clean  and  free  from 


CHILDREN'S  TEETH— IRREGULARITY    59 

decay  it  is  especially  important  that  the  parents  or  nurse 
should  understand  the  law  that  governs  the  correct 
development  of  the  dental  arches.  For  instance,  Figs. 
37  and  38  represent  the  normal  arch  of  a  boy  of  eight. 
Note  particularly  that  the  lower  four  incisor  teeth  in- 
closed in  a  bracket  should  always  occupy  their  full  space 


Fig.  37. — Normal  relation  of  a  child's  teeth  between  the 
ages  of  seven  and  ten.  The  permanent  incisors  have  suc- 
cessfully replaced  the  temporary. 

in  the  gradual  curve  of  the  arch,  so  that  the  permanent 
canines  can  come  in  at  the  age  of  eleven,  and  thus  make 
the  full  arch  in  the  lower  jaw.  For,  if  the  lower  teeth 
are  straight  and  of  full  width  the  upper  teeth  are  bitten 
and  hammered  into  the  proper  position.  This  is  es- 
pecially the  case  if  the  lower  first  permanent  molar  on 


60  EVERYDAY  MOUTH  HYGIENE 

either  side  bites  in  front  and  within  the  upper  first 
permanent  molar,  as  is  shown  by  the  connecting  hne  in 
Fig.  37.     It  is  especially  necessary  to  note  during  erup- 


Fig.  38. — Normal  arches  of  a  child  between  the  ages  of  seven 

and  ten 

tion  of  the  teeth  that  the  upper  teeth,  especially  those 
in  front,  should  never  slip  inside  of  the  lower  arch.  The 
parent  or  nurse  may  also  notice,  after  the  age  of  eight, 
if  the  arch  is  contracted.    (See  the  triangle,  Fig.  3S.) 


CHILDREN'S   TEETH— IRREGULARITY    61 

The  distance  between  the  anterior  pits  in  the  first  per- 
manent molars  should  always  greatly  exceed  either  side 
of  the  triangle  drawn  to  the  junction  of  the  cutting  edges 
of  the  central  incisors.  If  there  is  any  question  in  the 
mind  of  the  nurse  or  parents  on  these  points  the  advice 
of  the  dentist  should  immediately  be  obtained.  It 
should  be  especially  remembered  that  all  temporary 
teeth  erupt  before  the  age  of  three.  The  first  perma- 
nent molars  just  mentioned  erupt  at  the  age  of  six 
years,  sometimes  at  five,  and  it  is  especially  necessary 
that  these  teeth  should  be  kept  clean  and  never  ex- 
tracted under  the  impression  that  they  are  temporary 
teeth.     This  has  at  times  occurred. 

And  now  let  us  sum  up  the  points  to  be  especially 
noted  during  dentition.  The  low^r  front  teeth  should 
be  straight  and  untwisted  in  their  arch.  The  lower 
first  permanent  molars  should  always  bite  inside  and 
in  front  of  the  upper  first  permanent  molars,  as  shown 
by  the  cross  line  in  Fig.  37.  The  arch  should  have 
sufficient  width.  (See  Fig.  38.)  The  upper  teeth  should 
never  bite  inside  of  the  arch  of  the  lower  teeth;  and, 
above  all,  the  temporary  teeth  should  be  kept  clean  and 
free  from  decay,  so  that  until  absorbed  at  the  proper 
time  they  will  maintain  the  necessary  space  in  the  jaw 
for  the  permanent  teeth  to  emerge  from  the  gum  in 
their  normal  position. 

The  loss  of  a  temporary  tooth  through  decay  or  pre- 
mature extraction  is  a  serious  misfortune  for  the  child, 
and  usually  results  in  deformity  of  the  permanent 


62  EVERYDAY  MOUTH  HYGIENE 

teeth;  but  proper  care  of  the  temporary  teeth  in 
a  surprising  number  of  cases  will  result  in  a  perfect 
alignment  of  the  permanent  teeth. 

The  dentist,  of  course,  must  always  be  the  final  judge 
of  what  is  or  is  not  correct,  but  a  few  remarks  on  the 
subject  of  crowns  and  bridges  may  not  be  out  of  order. 
Any  permanent  bridgework  placed  in  the  mouth  in  a  way 
that  cannot  be  kept  as  clean  as  the  natural  teeth,  is  a 
menace  to  health  and  should  not  be  tolerated.  If  the 
dental  floss  and  brush  cannot  be  used  to  cleanse  all  sides 
of  a  fixture,  both  those  that  rest  on  the  gum  and  those 
that  are  exposed  to  the  action  of  the  saliva,  it  had  better 
far  be  removed  and  a  dental  plate  worn  instead.  Re- 
movable bridgework  that  can  be  taken  out  and  scrubbed 
during  the  cleansing  of  the  teeth  and  then  slipped  back 
securely  into  place,  is  now  possible  almost  anywhere; 
and  should  always  be  preferred  to  fixtures  that  cannot 
be  cleansed. 

Crowns  that  are  persistently  associated  with  bleeding 
during  the  process  of  flossing  and  cleansing  the  teeth 
should  be  considered  a  possible  source  of  systemic  in- 
fection, and  if  they  cannot  be  made  wholesome  they 
should  be  removed. 

Here  is  the  picture  of  a  man  with  healthy  teeth  and 
gums,  biting  on  an  instrument  that  shows  how  much 
pressure  he  can  exert  between  his  back  teeth.  (See 
Fig.  39.)  The  pointer  shows  that  he  is  creating  a  force 
equal  to  340  pounds.  He  surely  will  have  no  difficulty  in 
chewing  his  food.    He  can  only  exert  such  force  because 


J 


CHILDREN'S   TEETH— IRREGULARITY    63 

he  has  kept  his  teeth  clean  and  his  gums  healthy,  and 
while  you  may  not  all  be  able  to  bite  so  hard,  it  is  ad- 
visable for  the  sake  of  chewing  your  food  to  keep  your 


Fig.  39. — Gnathodynamometer.  For  measuring  the  force 
exerted  by  the  closing  of  the  jaws.  This  represents  a  man  exert- 
ing a  pressure  equal  to  340  pounds — over  t^wdce  his  weight. 


teeth  clean,  for  ordinary  food  will  sometimes  require 
over  a  hundred  pounds  pressure  before  it  is  thoroughly 
prepared  for  digestion  by  the  stomach. 


INDEX 


PAGE 

Abscess  from  decay  of  teeth 17-20 

Arches,  dental,  brushing  inside  of 51 

proper  development  of 59 

Back  teeth,  instrument  for  measuring  strength  of . .  .  .  63 

Beginning  pyorrhea 10 

Bridgework,  dangers  from 62 

Brush,  tooth 39 

Brushing  front  teeth  and  gums 44 

gums 40 

inside  of  dental  arches 51 

lower  wisdom  teeth 48 

side  teeth  and  gums 44 

teeth 37 

drawing  motion 47 

mechanics  of 42,  43 

rotary  motion 45 

wrong  way 38 

upper  wisdom  teeth 48 

Children's  teeth,  care  of 50 

irregularity  in 57 

Cleansing  teeth  and  gums 20 

time  necessary  for 7 

Crowns,  dangers  from 62 

Decay  of  teeth,  abscess  from 17-20 

Dental  arches,  brushing  inside  of 51 

proper  development  of 59 

5  65 


66  INDEX 

PAGE 

Dental  floss,  curative  action 10 

improper  use  of 21 

incorrect  way  of  inserting 29 

position  of,  for  cleansing  back  of  tooth 35 

front  of  tooth 3f 

left  lower  teeth 37,  "'' 

upper  side 27,28, 

right  lower  teeth j^ 

upper  side 31,  32 

positions,  preliminary 26,  33 

proper  method  of  application 22 

Dentifrice,  formula  for 55 

Floss,  dental.     See  Dental  floss. 

Front  teeth,  brushing  of 44 

Gnathodynamometer 63 

Green  stains  on  teeth,  removal 52 

Gums,  brushing 40 

cleansing  of 20 

infection  of,  brush  treatment 40 

disease  from 7 

Infected  gums,  brush  treatment  40 

Irregularity  in  children's  teeth 57 

Mouth  infection,  early  treatment 52 

wash,  peroxid  solution 50 

sodium  silicofluorid  solution 50 

Peroxid  solution  mouth  wash 50 

Pyorrhea,  beginning 10 

infection  of  system  from 14,  16,  17 

pocket 10-15 

advanced 13,  15 


INDEX  67 

PAGE 

Sodium  silicofluorld  solution  mouth  wash 50 

System,  infection  of,  from  pyorrhea 14,  16,  17 

Teeth,  back,  instrument  for  measuring  strength  of .  .  .  63 
brushing  of.     See  Brushing  teeth. 

:hildren's,  care  of 58 

irregularity  in, 57 

cleansing  of 20 

time  necessary  for 7 

decay  of,  abscess  from 1 7-20 

front,  brushing  of 44 

green  stains  on,  removal 52 

infection  of,  disease  from 7 

left  upper,  position  for  cleansing 27,  28,  30 

lower,  position  for  cleansing 33,  34,  37 

wisdom,  brushing  of 48 

normal  clean 8 

right  upper,  position  for  cleansing 31,  32 

side,  brushing  of 44 

unclean 8,  9 

upper  wisdom,  brushing  of 48 

wisdom,  neglect  of 39 

with  beginning  pyorrhea 10 

Tooth  brush,  improper     39,  43 

proper 40,  42 

pastes 54 

powders 54 

Unclean  teeth 8, 9 

Wisdom  teeth,  neglect  of 39 


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